An Exercise in Curiosity

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What’s so special about Physical Therapy?

When it comes to outpatient Orthopedic Physical Therapy, what does Physical Therapy offer that is intrinsically unique from other “overlapping” professions? I posed this question via a horribly worded tweet that lead to an interesting and very involved conversation. Check it out here.

Many of our treatment modalities are not confined to the domain of Physical Therapy, but are utilized by a broad spectrum of professionals. In terms of competitive advantages, exercise might be the weakest of our modalities. It has one obvious glaring shortcoming: the landscape of exercise is becoming flatter everyday. You can learn proper efficient exercise from any smart & experienced individual. They don’t have to be a Physical Therapist. They could be an athletic trainer, personal trainer, chiropractor…even your local gym rat. Information on exercise is becoming so ubiquitous that you could simply pull up a Youtube video to coach you through “corrective exercises”.

What about Ultrasounds & Electric Stimulation? Let’s put aside any knee-jerk reactions related to their effectiveness and think along the lines of Competitive Advantages. There is nothing stopping a chiropractor or athletic trainer from using these modalities. Even worse, utilizing these modalities requires a very short learning curve. Everything that involves binary decision-making combined with the potential for technological adoption will further flatten the competitive landscape and be vulnerable to outsourcing. Ultrasound & Electric Stimulation are no exceptions to this concept.

What about various joint & soft tissue mobilization techniques? The advantage will last only as long as the material is taught specifically only to Physical Therapists. Since Continuing Education is a capitalistic enterprise, these courses are usually offered beyond the confines of Physical Therapy. Therefore, any advantage conferred by these “techniques” is arbitraged against time. I believe Dry Needling fits under this umbrella. Once these “techniques” are utilized by other professionals, the advantage will moderate.

Is there any Evidence to “prove” our unique effectiveness as Physical Therapists? This article from 2001 was the only one brought to my attention. Notice that none of the main points are encouraging from an Outpatient Orthopedic point of view. According to the article, the only advantages conferred by being a Physical Therapist lies in niches.

If we can not, as a profession, produce quality data that we "matter" — Maybe we shouldn't exist? @jerry_durhampt @cinema_air

Speaking of evidence, more evidence doesn’t mean more effectiveness. It simply means “more evidence”. The data is democratic, and the evidence can be applied by anyone of any profession, regardless of who did the research and produced the evidence. Simply because we may claim to be the profession that produces a sizable amount of neuro-musculoskeletal research, that doesn’t mean it is applied exclusively within our domain. Evidence has a level of promiscuity that should be appreciated.

The twitter thread mentioned earlier turned into an octopus and grew in different directions. This one was interesting because it eventually hit on something I had in mind. It’s about the Framework of approach that might be unique to Physical Therapy.

According to Tim, our uniqueness lies in our integrative framework to address functional deficits of any individual. Based on this perspective, Physical Therapy isn’t about “what” we do as much as it is about “how” we do what we do. While this sounds powerful (which it is!), the tricky part of it is the variety of philosophies & approaches within the profession don’t seamlessly lend themselves to a unifying framework. Other professions also view themselves as systems that incorporate different perspectives into a Plan of Care. After all, “integrative” is quite the catch-phrase these days. A unique & integrative framework will only remain a unique advantage as long as the process to understanding and utilizing the framework requires substantial achievement and effort. Once these hurdles are either lowered or removed there will no longer be a unique value proposition.

Even worse, here’s what the research says about perception of Rehabilitation Professionals:

So, we don’t “own” any treatment modality, and we don’t have evidence to back up our unique effectiveness. Are we in a rat race against “sameness”? Back to the initial question:

Thanks Selena. This topic – Competitive Advantages of Physical Therapy – has been spinning in my mind off & on for the last 3-4 weeks. Still not quite sure what to make of it. Do we (outpatient orthopedic PT’s) do anything that is truly unique that isn’t vulnerable to adoption across professional lines??

It’s not the “do” as much as the “how” and “why” and our unique wealth of knowledge. There is no other professional in the industry that knows various medical conditions and the impact the condition can have on a life combined with knowledge of medications and the effect medications can have on function combined with what it takes to live and move with ease and the route to get there (living life and moving with ease). Another huge aspect is we do focus on empowering people… we desire our clientele to be independent and confident vs dependent upon us. (Okay… that may not be true all across the board, but it is for me.) That is just my opinion though.

1. Integration of knowledge/info of various medical conditions – many professionals can make this claim, including chiropractors, kinesiologists, osteopaths, and PM&R specialists (https://www.aapmr.org/patients/aboutpmr/Pages/default.aspx). Is there a Unique Value Proposition that sets us (as a whole) apart from them?

2. Knowledge of medications: it might be just me, but I find myself Googling most meds. I don’t know enough about them, and I certainly don’t know much about the newer drugs & their effects on our areas of interest. The fact that this information can be Googled immediately makes it a level playing field since anyone can search for this info.

I think you might be on the right track with the “how” > what we “do” that sets us apart. I’d love to hear more about that. What is it about the “how” that gives us a Competitive Advantage?

(Not sure I’ll be able to check back here for the rest of today. Hope the #solvePT chat goes well! And thanks for making it this week’s topic.)